Healthcare Provider Details

I. General information

NPI: 1376213512
Provider Name (Legal Business Name): MATTHEW RECKINGER-ROWE PHD,CPC, CMLC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2021
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3568 W INDUSTRIAL LOOP
COEUR D ALENE ID
83815-6016
US

IV. Provider business mailing address

3568 W INDUSTRIAL LOOP
COEUR D ALENE ID
83815-6016
US

V. Phone/Fax

Practice location:
  • Phone: 208-444-5683
  • Fax: 208-315-6616
Mailing address:
  • Phone: 208-444-5683
  • Fax: 208-315-6616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: